Abstract 246: Reversible Cerebral Vasoconstriction Syndrome and Spontaneous Hemorrhage are the Most Common Causes of Peripartum Subarachnoid and Intracerebral Hemorrhage.

Abstract

Introduction: Aneurysmal and hypertensive hemorrhages are the most common causes of subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) in the general population, but the peripartum period has several unique characteristics that increase the risk of hemorrhage, including expanded plasma volume, increased vascular tone, hypercoagulability and elevation of catecholamines during delivery. Hemorrhagic and ischemic stroke accounts for 12% of all maternal deaths, and is a significant source of morbidity as well. Hypothesis: We hypothesized that peripartum SAH and ICH is due to distinctly different pathophysiologic processes compared to the general population. Methods: We conducted a chart review of inpatient stroke service admissions at a large urban academic center between the years 2006 to 2010 for women under the age of 40 with a diagnosis of SAH or ICH. Of those, we identified peripartum patients, determined etiologies for their hemorrhages, and documented pertinent risk factors. Results: Fifty-one patients under the age of 40 were identified with SAH or ICH. Of those, eight were peripartum and half were post cesarean section. The two most common etiologies for SAH or ICH were spontaneous hemorrhage, and reversible cerebral vasoconstriction syndrome. Other etiologies included coagulopathy and hypertension/preeclampsia. None of the peripartum hemorrhages were noted to be aneurismal. Conclusions: Etiologies in peripartum SAH and ICH differ from the general population. Aneurysmal bleeds were absent in our case series. Rates of SAH and ICH may be higher in patients who underwent cesarean section. In conclusion, peripartum subarachnoid and intracranial hemorrhages have a different pathophysiologic process than in the general population.